The article describes a cognitive structural theory of how nurses conceive or understand the personhood of patients. The theory postulates three levels that have the properties of cognitive structures. The third and highest level is held to be a meta-ethical theory of the moral structure of care. For nurses operating with level-III understanding, critiques of justice and care-based ethics are further held to be synthesized within.

This article describes a theory of nurses' conception of personhood in patients, which synthesizes justice-based and caring-based ethical theories and suggests the developmental path toward a moral ideal in the nurse-patient relationship. The theory is within the Piagetian tradition, which holds that the comprehension of key phenomena with particular relevance to human life develops along a staged path of qualitatively different and increasingly sophisticated mental schemata used to perceive, interpret, and interact with each category of phenomenon. A staged progression of development coupled with a particular phenomenon is referred to as a cognitive structure. Phenomena for which cognitive structures have been described are physical objects, morality, and causality by Piaget, 1-3 moral reasoning by Kohlberg, 4 and meaning-making by Kegan. 5 The phenomenon addressed by empathetic maturity is 'other people'; that is, the self's understanding of personhood in others. Essentially, empathetic ...